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   Table of Contents - Current issue
January-June 2021
Volume 5 | Issue 1
Page Nos. 1-50

Online since Saturday, July 3, 2021

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From the Pen of Editor in Chief p. 1
Naresh K Panda
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Is there an association between the anteroinferior cerebellar artery vascular loop and asymmetrical sensorineural hearing loss? p. 2
Abhijeet Bhatia, Pranjal Phukan, Barun Sharma, Goutam Polley
Background: Asymmetrical sensorineural hearing loss is usually idiopathic. Vascular loops are commonly implicated in compression disorders involving lower cranial nerves, which can be relieved on surgical decompression. However, the cause–effect relationship between vestibulocochlear symptoms and vascular loops is still controversial. Objective: The objective of this study is to look for an association between the presence of anteroinferior cerebellar artery (AICA) loops and asymmetrical sensorineural hearing loss of unknown etiology. Methods: Twenty-four patients with complaints of asymmetrical hearing loss of no discernible cause underwent a magnetic resonance imaging of the brain between August 2015 and August 2017. The AICA loops were graded using two classifications, namely Chavda classification and a grading system proposed by Adam Gorrie et al. (second classification). The vascular loops were correlated with the presence of hearing loss, tinnitus, and vertigo. Results: Hearing loss did not correlate significantly with the vascular loops on grading with either Chavda or the second classification. The presence of tinnitus or vertigo too did not correlate significantly with the grading of vascular loops. The caliber of AICA too did not correlate significantly with hearing loss. Conclusion: Vascular loops do not appear to be associated with asymmetrical hearing loss and other cochleovestibular symptoms.
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Effects of probe tip placement on static acoustic admittance at the plane of measurement p. 8
Preeti Sahu, Debadatta Mahallik
Introduction: Tympanograms are recorded at the plane of the probe tip in the ear canal, consequently, this recording is called a tympanogarm in the plane of measurement and it includes both the acoustic admittance of the trapped volume of air between the probe tip and the tympanic membrane and the admittance of the middle ear system at the tympanic membrane. Materials and Methods: Eighty three participations (166 ears- 85 right ears, 81 left ears) were selected for the study. participants who had negative middle ear pressure greater than -50dapa and + 50 dapa and air and bone conduction thresholds gap of equal or more than 15 dB were excluded from the study. Data Analysis: Pearson correlation coefficient was carried out to see the relationship between residual ear canal volume (RECV) and acoustic admittance (Ya) and as well as for the tympanometric peak pressure (TPP). Results: Results shows there is strong positive correlation (r =0.854, P <0.001) between the residual volume in the ear canal and admittance. Acoustic admittance were well correlated with the residual ear canal volume with coefficient of determination of r^2 = 0.793. In case of the middle ear pressure, it has been shown that there is positive moderate correlation (r = 0.679, P < 0.001) between the middle ear pressure and acoustic admittance with coefficient of determination of r^2 = 0.473. Conclusion: The shift of probe tip placement in the ear canal and middle ear pressure variation changes the acoustic admittance value during immitance audiometry.
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Impact of adenoidectomy/adenotonsillectomy on hearing threshold and middle ear pressure p. 12
K S Gangadhara Somayaji, A Fathima, S Saimanohar
Introduction: Enlarged adenoids may cause obstruction of the nasopharynx and blockage of the Eustachian tube and thereby preventing ventilation of the middle ear – mastoid system. It can also act as a reservoir for bacteria causing frequent middle ear infections. This study was done to assess the middle ear pressure (MEP) and hearing threshold before and after adenoidectomy or adenotonsillectomy. Materials and Methods: Fifty-four children aged between 4 and 12 years undergoing adenoidectomy or adenotonsillectomy were included in the study. Pure tone audiometry (PTA) and impedance audiometry were done preoperatively and postoperatively twice, on the 2nd day and at 6th week to assess the changes in hearing threshold and MEP. Statistical analysis was done using paired t-test and Chi-square test to determine the changes in hearing threshold and MEP. P < 0.05 was found to be statistically significant. Results: Of the 54 patients (108 ears) studied, 26 ears (24%) showed air–fluid level and 19 ears (17.6%) had dull-retracted tympanic membrane. The mean preoperative PTA value was 15.95 ± 8.19 dB. The mean preoperative MEP value was −63.69 ± 88.9 mm H2O. Postoperatively on 2nd postday, both the values were higher and at 6th week, there was an improvement as compared to preoperative and immediate postoperative values. At 6th week postoperatively, it was also observed that 52 children had tympanogram as type A, confirming the improvement in MEP. All these changes were statistically significant (P < 0.005). Conclusion: Adenoidectomy or adenotonsillectomy alone does improve the Eustachian tube function, especially in otitis media with effusion. Myringotomy with grommet insertion may not be necessary in all the cases.
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A prospective cohort study on ossicular reconstruction using autologous incus or cartilage in chronic otitis media p. 18
SM Joy, P Karthikeyan, DT Pulimootil
Background: Loss of hearing resulting from ossicular discontinuity is prevalent, with chronic otitis media being the primary causative factor. Aim and Objectives: The study aimed at evaluating the potential of autologous incus and cartilage in restoring hearing as well as identifying predictors of ossiculoplasty outcomes. Methodology: Patients with autologous incus constituted Group I (n = 52) and patients with autologous cartilage constituted Group II (n = 48). Reliability of pre-operative predictors such as pure-tone average, air-bone gap, and middle ear risk index (MERI) scores in anticipating hearing associated outcomes of ossiculoplasty was investigated. Inferential statistics were employed. Results: Group I patients displayed better postoperative outcomes in terms of pure-tone audiometry than Group II counterparts (P = 0.0035). Age (P = 0.044), MERI (P = 0.021) and gender (P = 0.046) proved to be reliable indicators. Conclusion: Autologous incus can be explored as a competent ossiculoplasty material in developing countries.
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Middle ear surgery and taste dysfunction: Prevalence and determinants p. 24
Basavaraj Patil, Renu Rajguru, Dilip Raghavan, Inderdeep Singh, Rahul Naga
Introduction: Middle ear surgery involves handling of chorda tympani nerve. Patients after middle ear surgery may complain of taste disturbance and lingual numbness. Clinical testing of taste is not a test which is routinely performed in ENT Clinics. Consequently, the prevalence of postoperative taste dysfunction remains largely unknown. Aim: The aim of this study is to determine taste function in patients before and after middle ear surgery with a clinically suitable test and to find out the factors which determine the extent of taste dysfunction. Setting: The study design involves tertiary care hospital. Materials and Methods: This was a prospective observational study conducted from October 2017 to October 2019 in the ENT department of a tertiary care hospital. Hundred patients undergoing middle ear surgery fulfilling the inclusion criteria were considered as the study population. All patients underwent assessment of taste thrice: the day before the operation, seventh postoperative day and at 3 weeks after surgery by administering three kinds of taste testing solutions for testing sour, sweet, and salty taste in varying concentrations. Scoring was done and tabulated followed by statistical analysis. Results: Nineteen (19.0%) participants had taste disturbance after undergoing middle ear surgery. The factors which influenced whether injury to the chorda tympani causes tastes dysfunction included the age of the patient, extent of the injury, type of middle ear disease, and the type of surgery done. Conclusions: Patients undergoing middle ear surgery may exhibit taste dysfunction. However, in the majority of the cases, this goes unnoticed by the patient and is transitory. The sense of taste has a great capacity to compensate after partial dysfunction. However, preoperative information to the patients regarding the existence of potential taste disturbance, and that it is transitory usually, but is untreatable if persistent, may prevent any medicolegal problems later.
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A case of cystic hygroma in adults and its management p. 29
Pandiaraja Jayabal
Cystic hygroma is a congenital abnormality due to lymphoid sequestration in the sac. Incidence of cystic hygroma in adult is rarely report. It is most commonly present in posterior triangle as cystic mass. Even in adult patient, any cystic lesion present in posterior triangle cystic hygroma should be considered one of the differential diagnoses. Here, we present a rare occurrence of cystic hygroma in adult male patient present as cystic lesion. This case is reported for its adult presentation and discusses the management for cystic hygroma.
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Bilateral nasolabial cyst p. 32
Soumick Ranjan Sahoo, Mandira Sarma
Nasolabial cyst is an uncommon nonodontogenic extraosseous cyst. Bilateral cysts are rare, and very few are reported in literature. They present as slow-growing swellings in the nasolabial region causing cosmetic deformity and nasal obstruction. We report a rare case of a 59-years-old female who was diagnosed as bilateral nasolabial cyst based on clinical and computed tomography scan findings and underwent excision by sublabial approach. Histopathological examination confirmed the diagnosis.
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Endoscopic orbital transposition for inverted papilloma in an unusually large supra orbital ethmoidal cell p. 35
Vinod Felix, Mariappan Vivek, Veerasigamani Narendrakumar
The management of inverted papilloma involving frontal sinus and supraorbital ethmoidal cells is still challenging even for the well-trained rhinologists. These cases sometimes require an external approach, but now with the technique of endoscopic orbital transposition many such cases are handled effectively endonasally. Here in our case report, we are describing an unusually large supraorbital ethmoidal cell, which has pneumatized all the way above the orbit, from the frontal sinus to the anterior clinoid process and hence with the optic nerve lying inside this cell. We will be describing how we still could tackle this endoscopically with the modified endoscopic Lothrop and orbital transposition.
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Anterior craniofacial resection for squamous cell carcinoma ethmoid sinus involving anterior skull base p. 38
Sumeet Angral, Saurabh Varshney, Rajnish Kumar Arora, Manu Malhotra, Amit Kumar Tyagi, Amit Kumar
Sinonasal squamous cell carcinoma (SCC) is a rare form of head-and-neck malignancy, with an incidence of 3%, while SCC of the ethmoid sinus is even more infrequent with relatively few cases cited in the literature. Management of anterior skull base tumors is complex due to the anatomic detail of the region and the variety of tumors that occur in this area. Currently, the “gold standard” for surgery is the anterior craniofacial resection. A 61-year-old man with a locally advanced SCC of the ethmoid sinus involving orbit with intracranial extradural extension was surgically treated performing anterior craniofacial resection followed by adjuvant intensity-modulated radiation therapy to the tumor bed. Currently, the “gold standard” for ethmoid carcinoma with intracranial extension is the anterior craniofacial approach. It allows wide exposure of the complex anatomical structures at the base of the skull permitting monobloc tumor resection. A multidisplinary team approach involving an otolaryngologist, neurosurgeon, plastic surgeon, pathologist, and radiologist is required for effective management of these tumors.
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Closure of irradiated tracheocutaneous fistula with pectoralis major muscle flap and split skin graft p. 42
George Taliat, Abhijit Gogi, Kumaraswamy Mohan
Tracheocutaneous fistula in an irradiated neck is often difficult to manage. Simple closure often leads to dehiscence and recurrence. We present a patient with supraglottic carcinoma, postradiotherapy, who presented with a persistent trachea-cutaneous fistula. We excised the fistula along with surrounding indurated tissue and covered the defect adequately with skin graft for tracheal lining and pectoralis muscle flap as a muscle cover. Fistula was closed and wound healed well. There was no recurrence of fistula as evidenced with indirect laryngoscopy. Pectoralis major flap is a well-vascularized flap that can be used to cover defects in anterior lower neck. Simple skin graft with a cover of muscle flap was enough to give adequate tracheal lining.
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Hijab pin: Carinal invasion of a migrating airway foreign body p. 46
Neha Shakrawal, Bikram Choudhury, Kapil Soni, Darwin Kaushal, Amit Goyal
Foreign-body aspiration is a serious and deadly event which can lead to major complications. This is more common in children and if not promptly managed, can lead to significant complications. We here report a rare case of hijab pin inhalation into the trachea which migrated to the carina in a 3-year-old child which was successfully removed by rigid bronchoscopy.
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Lemierre's syndrome with chest wall metastasis caused by klebsiella pneumonia p. 49
Mansoor C Abdulla
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